Saturday, June 23, 2012

Oregon Studies the Value of Medicaid

“The study put to rest two incorrect arguments that persisted because of an absence of evidence. The first is that Medicaid doesn’t do anything for people, because it’s bad insurance or because the uninsured have other ways of getting care. The second is that Medicaid coverage saves money. It’s up to society to determine whether it’s worth the cost.” 
Don’t miss the NY Times report on Oregon’s insurance/health-care experiment.

Tuesday, June 19, 2012

Checking into "God's Hotel"

The emergent wonders of medical science can make relatively recent practices seem like relics from the Dark Ages. And yet not all change is for the better.
For Dr. Victoria Sweet, change transformed San Francisco’s Laguna Honda Hospital from “the last almshouse in America” into an “efficient, computerized 21st-century rehabilitation center.” This transformation has educated Dr. Sweet, a proponent of slow medicine, in the “inefficiency of efficiency.”
Dr. Sweet spent twenty years practicing medicine at Laguna Honda, a large facility caring for the  city’s destitute and ill, and has written about this experience in “God’s Hotel: A doctor, a hospital and a pilgrimage to the heart of medicine.”

Reading Dr. Abigail Zuger’s review of “God’s Hotel” has put it on my summer reading list, along with “Writer, M.D.: The best contemporary fiction and nonfiction by doctors” and Kenzaburo O’s “A Personal Matter,” which I recently discovered on a short list of “moral distress in literature,” along with “Huckleberry Finn” and Toni Morrison’s “The Bluest Eye.”

Zuger writes of Laguna Honda: “At one point, almost every county in the nation had a place like it, where patients could live for months, years, as long as it took. These medical back wards, like their psychiatric counterparts, have now evaporated in the name of community-based services: the old Laguna Honda was called the last almshouse in America.” 
Through excerpts, reviews and interviews, “God’s Hotel” has the feel of a companion piece to the compelling, contemporary documentary film “The Waiting Room,” recorded in Oakland’s Highland Hospital. Where “God’s Hotel” documents the way the indigent and ill were treated in a bygone time not so long ago, “The Waiting Room” shows the often dreadful way they are treated now, just across the San Francisco Bay.
There is no longer the money or the time for the kind of humane care that Laguna Honda provided.
“Caring for those who care little for themselves entails immense frustration and wasted time, but time was one thing the doctors had -- time and the medieval medical interventions of regular meals, clean linens, cheerful surroundings and the opportunity for careful observation,” Dr. Zuger writes. “Occasionally a remarkable transformation would result from very little more than those simple things, the miserably self-destructive becoming well and whole.”
What, to Sweet, makes a good doctor? "The good doctor makes the right diagnosis and prescribes the proper treatment. But the better doctor also walks with his patient to the pharmacy. And the best doctor waits in the pharmacy until his patient swallows the medicine."